Optimising outcome assessments for clinical practice and stroke trials

To prove that a treatment has been useful for stroke survivors we need ways of measuring benefit to the patient. Stroke is a leading cause of disability and so an important measure is the degree of disability that the patient had before and after the treatment. We have lots of tools and scales for measuring different aspects of recovery from stroke. If a scale is poor at measuring recovery then there is the danger that positive treatment effects are missed or that we erroneously assume treatments have worked when there has been no real difference to the patient. We have described and tested some of the more popular assessment tools, to try and improve assessment of stroke survivors both in scientific studies and also in day-to-day practice.

Project summary

Stroke remains the leading cause of disability in the world. Substantial improvements have been made in the acute treatment and rehabilitation of stroke patients informed by the growing evidence base in the field. Clinical trials have been at the centre of these advances. To prove efficacy of any intervention requires a robust assessment of stroke outcome. We have created a body of work describing uses and properties of scales used for outcome assessment, particularly functional outcome assessment, in clinical stroke trials. We have particularly focussed on the most prevalent and arguably the most useful functional measures the modified Rankin Scale (mRS) and the Barthel Index (BI).

Our comprehensive work in stroke outcomes has incorporated systematic review; original research; statistical modelling; educational interventions and medical history. Outputs have included twenty papers in peer reviewed scientific journals; creation of training and certification resources for mRS and BI that are internationally recognised and are now industry standard and creation of a novel method of video based group adjudication.

Our work to describe the properties and improve the application of outcomes assessment for stoke continues; in particular future projects will look at cognitive scales and rehabilitation trials.

References (selection)

  1. Quinn TJ, Dawson J, Walters MR, Lees KR. Reliability of the modified Rankin Scale systematic review. Stroke 2009;40:3393-5.
  2. Quinn TJ, Langhorne P, Stott DJ. Barthel index for stroke trials: development, properties, and application. Stroke 2011;42:1146-1151.
  3. Quinn TJ, McArthur KS, Ellis G, Stott DJ. Functional assessment in older people. BMJ 2011;343:d4681.
  4. Quinn TJ, Lees KR, Hardemark HG, Dawson J. Walters MR. Initial experience of digital training for modified Rankin scale assessment in clinical trials. Stroke 2007;38:2257-61.
  5. Quinn TJ, Dawson J, Walters MR, Lees KR. Exploring the reliability of the modified Rankin scale. Stroke 2009; 40:762-6.